The Clinical Chemistry Service at MSK is composed of a team of seventy healthcare professionals including two PhDs, two MD PhDs, one MD and six supervisors who work collaboratively in one of the busiest and preeminent chemistry hospital laboratories in New York City, performing approximately 5 million tests annually. Our team has standardized chemistry testing at all of our regional locations with an emphasis on quality and turnaround time, and we develop and validate new methodologies when there is a clinical need. Our attendings review and sign out serum protein electrophoresis cases, are responsible for routine as well as specialized testing, and share clinical responsibilities at all MSK regional sites. Approval from the New York State Department of Health is obtained for use of all “Lab Developed tests” for our patients.
 
The service is led by Lakshmi V. Ramanathan.

MSK’s hematology service offers excellent technical and laboratory expertise at each of our state-of-the art laboratories in Manhattan, New Jersey, Westchester, and Long Island.
At the main hematology laboratory, the Center for Laboratory Medicine (CLM), we perform complete blood counts (CBCs) with or without differentials, coagulation testing, and urinalysis. The CBCs are run on an automated Sysmex line of analyzers with a Cellavision instrument. If relevant abnormalities are detected, the sample is sent to the Cellavision for digital morphology assessment. Additionally, images from Cellavision instruments taken at other locations are reviewed at the CLM, streamlining workflow, and utilizing the expertise at the CLM.  Routine coagulation testing including PT, aPTT, fibrinogen, d-dimer, and anti-Xa, are available 24 hours a day. More specialized testing such as detection of lupus anticoagulants, testing of specific coagulation factors, mixing studies, and platelet aggregation, which require more technical expertise and interpretation, are performed during business hours, Monday-Friday. The laboratory also performs cell counts and differentials on body fluids and cerebrospinal fluids with morphologic analysis reviewed by a laboratory director when abnormalities are present.  Both macroscopic and microscopic urinalysis testing is performed on automated instrumentation with minimal intervention needed by the technologists. Only when certain flags are triggered does the technologist need to confirm their presence under a microscope.

Hematology and coagulation instrumentation and methods are harmonized across all MSK locations in order to standardize testing while maintaining the same high level of quality across all sites. The CLM serves as the coordinating site.

The Clinical Hematology Service is led by Lauren McVoy.

The Clinical Microbiology Service at MSK focuses on the detection, identification and characterization of microbes that cause a wide range of infections in cancer patients. These infections can be caused by the underlying cancer, and sometimes the associated treatment, which results in a decrease in immune system function causing an increased risk of developing infections.

The service includes attending microbiologists and clinical laboratory scientists who integrate both conventional and state-of-the art technologies to detect pathogens in cancer patients presenting with signs of infection. The laboratory offers comprehensive testing in bacteriology, antimicrobial susceptibility, mycobacteriology, mycology, parasitology, virology, and infectious disease serology, using technologies such as real-time PCR, solid and liquid microarrays, nucleic acid sequencing, including next generation sequencing, MALDI-TOF mass spectrometry and total laboratory automation platforms, which enable digital microbiology and a more rapid and accurate approach to the diagnosis of infectious diseases.

Our attending members provide consultations on a selection of diagnostic tests as well as interpretation of test results. Faculty on the clinical microbiology service are leaders in the development of rapid molecular diagnostic tests for infectious diseases and in the methods used to identify antibiotic resistance in microbes, which is information that is critical to initiate appropriate treatment. The team engages in numerous clinical and translational research projects including epidemiology studies and patient outcome studies, often in collaboration with clinical services including MSK’s Infectious Diseases Service.

The Clinical Microbiology Service is led by Esther Babady.

With cytology, diagnosis is made on the basis of dispersed cells rather than samples of tissue. These cells are obtained from fluids (such as urine or sputum) or by using fine needle aspiration or brushing techniques. In the past, cytology was used mostly as a screening tool — Pap smears to detect precancerous lesions of the cervix, for example — but advances in imaging technologies have led to an increase in the number of biopsies that are performed using minimally invasive fine needle aspiration. These biopsies provide cells that can be analyzed for diagnosis and for treatment monitoring.

MSK’s Cytology Service, which focuses on solid tumors, is composed of cytopathologists who are supported by a dedicated staff and state-of-the-art infrastructure, including laboratories for immunohistochemistry, flow cytometry, cytogenetics, and molecular pathology. The service has an active fine needle aspiration practice, in which specially trained cytopathologists employ ultrasound guidance to more accurately direct biopsies. Our cytopathologists also use leading-edge telepathology systems so we can rapidly assess biopsies performed at MSK’s regional sites. In addition, the service has an active fellowship program that’s accredited by the Accreditation Council for Graduate Medical Education; we host three fellows per year.

The Cytology Service is led by Oscar Lin.

Diagnostic molecular pathology focuses on characterizing tumors based on the genetic changes in their cells. This diagnosis forms the basis for targeted therapies, for which tumors are analyzed and matched with appropriate drugs based on the genetic alterations that are driving cancer growth. In some cases, genetic changes can identify people who are candidates for a cancer clinical trial.

Since 2014, pathologists in the Molecular Diagnostics Service have been using MSK-IMPACT to analyze the tumor DNA of essentially all MSK patients with advanced cancer. MSK-IMPACT is based on next-generation sequencing, which means that the most-critical parts of the cancer genome can be profiled very quickly and with great sensitivity. The test allows us to detect hundreds of mutations and other genetic changes in tumors. Being able to use this test as part of a care plan is a noteworthy accomplishment.

Additionally, the laboratory performs dozens of other sophisticated molecular tests on tumor samples, using a wide array of technologies. Separate laboratories perform studies for chromosomal alterations using karyotyping and fluorescence in-situ hybridization (cytogenetics) as well as assessing for hereditary mutations in cancer predisposition genes (diagnostic molecular genetics).

The Diagnostic Pathology Service is led by Marc Ladanyi.

Research in the Experimental Pathology Division is focused on decoding the complex changes that occur in cancer cells. Members of this team investigate the molecular basis for the morphologic features observed when tumor tissue is examined under the microscope.

MSK’s experimental pathologists have pioneered much of the DNA analysis technology that’s used to improve diagnoses and develop personalized treatments. Thanks to this work, we now have extraordinary opportunities to provide insights into what causes cancer to form or progress, and to suggest strategies for blocking it. Another area that this practice has helped immensely is in subtyping rare tumors — a feat that has always been challenging on the basis of histology alone.

Hematopathology analyzes cancers that originate in the hematolymphoid system. This includes the blood, bone marrow, lymph nodes, and other lymphoid tissues. Everyone diagnosed with a blood cancer at Memorial Sloan Kettering has their samples analyzed by a member of MSK’s expert hematopathology team.

We review about 20,000 samples every year. For each one, we provide a comprehensive diagnostic report that integrates complex information from morphological assessment, immunohistochemistry and flow cytometric analysis, and cytogenetic and molecular genetic studies. Our laboratories are internationally recognized for their innovation in clinical test development. In particular, we are well regarded for our development of assays to detect minimal residual disease and comprehensive proteomic and genomic analysis, for which we work with the Molecular Diagnostics Service.

The Hematopathology Service is led by Ahmet Dogan.

Surgical pathology is one of the major functions of the Pathology Department. Surgical pathologists make their diagnoses by looking at tissue samples under a microscope. Samples from a surgery or biopsy are processed, embedded in paraffin, cut into thin slices, and placed on a glass slide. They are then stained to make the cells visible under magnification.

If a disease is complicated, additional testing may need to be done. For example, immunohistochemistry procedures direct labeled antibodies against particular proteins that are specific to certain tumor types or genetic changes. Defining the spectrum of protein expression allows a more accurate diagnosis and often provides prognostic or therapeutic information as well. Our Surgical Pathology Service can also perform diagnoses using frozen sections if a quicker diagnosis is needed. Findings that can guide a procedure can be immediately shared while a surgeon is still in the operating room.

The Surgical Pathology Service is led by Meera Hameed.

The Transfusion Medicine and Cell Therapy Service is a team of highly-skilled laboratory and clinical professionals with diverse expertise in delivering direct patient care, diagnostic testing, and a variety of blood and cellular products. We partner with clinical practitioners at Memorial Sloan Kettering Cancer Center (MSK) to provide life-sustaining blood and cellular products and clinical services to patients based on their needs, while following evidence-based practices.

Our service provides transfusion support at our main hospital and several other locations in Manhattan and at MSK’s regional facilities in New York and New Jersey. We transfuse over 50,000 blood products every year to our patients. Our apheresis service performs different types of therapeutic apheresis procedures, including plasma exchange, red blood cell exchange, cellular depletions, and external counterpulsations. The Blood Bank performs testing on thousands of patient samples monthly for both routine tests, like blood typing and antibody screening, and complex immunohematology evaluations and transfusion reactions.

Our service supports MSK patients who receive transplantations (bone marrow transplant, hematopoietic stem cell transplantation) and cellular therapies in several ways. Our Blood Bank and human leukocyte antigen laboratories perform diagnostic testing to determine the attributes of both recipients and donors. Our apheresis service collects the cellular starting material for patient therapies and our cell therapy laboratory processes them for final infusion. We manage the entire process of delivering conventional cellular therapies and new innovations in treating cancer with cell therapy from donor to patient. Following transplantation, highly-sensitive next-generation sequencing is used to monitor the different cell lineages of the transplanted graft.

To further support our community, our service also operates a blood collection service located in our main hospital. Through the generosity of our dedicated blood donors, we collect and transfuse blood products for many patients every day. Consider making an appointment to donate blood in our donor room!

The Transfusion Medicine and Cell Therapy Service is led by Dayand Borge.